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Abstract: SA-PO134

Renal Pathologies and Patient Outcomes Post Allogeneic Stem Cell Transplantation

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Ratanasrimetha, Praveen, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Mamlouk, Omar, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
  • Tchakarov, Amanda, The University of Texas Health Science Center at Houston, Houston, Texas, United States
  • Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Background

Renal complications associated with hematopoietic stem cell transplantation (HSCT) have been reported to be as high as 55% with acute kidney injury (AKI) and proteinuria being the most common presentations. With AKI impacting both renal and survival outcomes, a renal biopsy remains the gold standard to diagnose the etiology of AKI. Below we investigated the scope of renal pathologies in allogeneic SCT recipients and their renal outcomes.

Methods

A single center retrospective chart review of all patients who underwent a renal biopsy post allogeneic SCT from 2007-2022. We collected baseline characteristics, serum creatinine, proteinuria, treatment for the renal pathology, and the renal outcomes. Renal response was defined as any improvement in creatinine after treatment either complete return to baseline or partial response.

Results

We identified 60 cases with the three most common underlying cancers being leukemia, lymphoma and myeloma. Indications for kidney biopsy were mostly due to unexplained AKI (83.3%) and proteinuria/hematuria (17%). TMA was the most common pathology finding at 28.3% , followed by BK nephropathy (15%), FSGS and membranous nephropathy(14.9%) , acute tubular injury(13%), acute interstitial nephritis(10%), amyloidosis (6.6%), MGUS (5%), diabetic nephropathy (3%), and IgA nephropathy and MPGN(3.2%). Acute and chronic TMA was the most common pathology. Two out of 5 treated with rituximab had partial response, 1 out of 3 treated with eculizumab had a partial response, all 3 patients switched from tacrolimus to rapamycin had a complete renal response, 3 patients had no treatment with one patient with improved renal function, one patient was treated with cellcept with partial response, and one patient was treated with naprolisumab with no renal response. One third of the patients with renal TMA had died.

Conclusion

Based on a single center 15-year experience of kidney biopsies post allogeneic SCT it is evident that transplant related TMA remains the leading cause of SCT related AKI post allogeneic SCT.
Renal TMA carries a poor overall prognosis and there is still no established guideline for its treatment in recipient of SCT. Based on our center experience, switching GVHD prophylaxis from tacrolimus to sirolimus might improve renal outcome. Renal response to anticomplement therapy and rituximab was variable.